Chronic Female Pelvic Pain

Topic Overview

Is this topic for you?

This topic focuses on pelvic pain that has lasted
longer than 6 months. If you have new, sudden pelvic pain, see your doctor as
soon as you can. To learn more about new pelvic pain, see the topic
Abdominal Pain, Age 12 and Older .

What is chronic female pelvic pain?

Female pelvic
pain is pain
below a woman's belly button. It is considered chronic (which means
long-lasting) if you have had it for at least 6 months. The type of pain varies
from woman to woman. In some women, it is a mild ache that comes and goes. In
others, the pain is so steady and severe that it makes it hard to sleep, work, or
enjoy life.

If your doctor can find what's causing the pain,
treating the cause may make the pain go away. If no cause is found, your doctor
can help you find ways to ease the pain and get back your quality of life.

Physical or sexual abuse. Experts aren't sure why
this is so, but about half of women with chronic pelvic pain have a history of
abuse.footnote 1

Doctors don't really understand all the things that can
cause chronic pelvic pain. So sometimes, even with a lot of testing, the cause
remains a mystery. This doesn't mean that there isn't a cause or that your pain
isn't real.

Sometimes, after a disease has been treated or an
injury has healed, the affected nerves keep sending pain signals. This is
called neuropathic pain. It may help explain why it can
be so hard to find the cause of chronic pelvic pain.

What are the symptoms?

The type of pain can vary
widely and may or may not be related to menstrual periods. Chronic pelvic pain can include:

Pain that ranges from mild to severe.

Pain that ranges from dull to sharp.

Severe
cramping during periods.

Pain during sex.

Pain when
you urinate or have a bowel movement.

Chronic pain can lead to
depression. Depression can cause you to feel sad and
hopeless, eat and sleep poorly, and move slowly.

How is chronic female pelvic pain diagnosed?

At
your first visit, your doctor will do a complete
pelvic exam to look for problems with your
reproductive system. The doctor will also ask questions about your past and
present health and about your symptoms. You may have some tests, such
as:

Emotional issues can play a big role in chronic pain.
Your doctor may ask questions to find out if depression or stress is adding to
your problem. You may also be asked about any past or current sexual or
physical abuse. It can be hard to talk about these things, but it's important
to do it so you can get the right treatment.

If the first tests
don't find a cause, you may have other tests that show pictures of the organs
in your belly. These may include:

You may also have a type of
minor surgery called
laparoscopy (say "lap-uh-ROS-kuh-pee"). In this
surgery, the doctor puts a thin, lighted tube with a tiny camera through a
small cut in your belly. This lets the doctor look for problems like growths or
scar tissue inside your belly.

Finding the cause of pelvic pain
can be a long and frustrating process. You can help by keeping notes about the
type of pain you have, when it happens, and what seems to bring it on. Show
these notes to your doctor. They may give clues about what is causing the
problem or the best way to treat it.

How is it treated?

If your doctor found a problem
that could be causing your pelvic pain, you will be treated for that problem.
Some common treatments include:

Birth control pills or hormone treatment for
problems related to your periods.

Surgery to remove a growth,
cyst, or tumor.

Medicine to treat the problem, such as an
antibiotic for infection or medicine for irritable
bowel syndrome.

Chronic pain can become a medical problem in itself.
Whether or not a cause is found, your doctor can suggest treatments to help you
manage the pain. You may get the best results from a combination of treatments
such as:

Pain relievers called
NSAIDs, like ibuprofen (such as Advil or Motrin) or
naproxen (such as Aleve). You can buy these
over the counter, or your doctor may prescribe
stronger ones. These medicines work best if you take them on a regular
schedule, not just when you have pain. Your doctor can tell you how much to
take and how often. Be safe with medicines. Read and follow all instructions on the label.

Tricyclic antidepressant medicine, which can
help with pain and with depression.

You may need to try many treatments before you find the
ones that help you the most. If the things you're using aren't working well,
ask your doctor what else you can try. Taking an active role in your treatment
may help you feel more hopeful.

Cause

Female pelvic pain is typically caused by a medical condition involving the reproductive organs, urinary tract, lower gastrointestinal tract, or muscles of the abdominal wall. Some causes are always short-term (acute), and others can become long-lasting (chronic) unless successfully treated.
Sometimes, no cause can be found.

Pain with no known cause

Experts don't yet understand all possible causes of pelvic pain, especially when it has become chronic. So even after a lot of testing, many women never find out the reason for their pain.

One reason might be what's called neuropathic pain. Long after a disease or injury
has healed, nerves can continue firing pain signals. This is thought to be caused by an
overloading of the
nervous system by extreme or long-lasting pain.

Not finding a cause doesn't mean that there isn't one or that there's no possible treatment.

Problems with the reproductive system that can cause chronic pain

Endometriosis. This is when the tissue lining the inside of the uterus starts growing outside of the uterus.

Adenomyosis. This is when the lining in the uterus starts growing into the uterine muscle.

Noncancerous (benign) tumors of the uterus, such
as
fibroids or
polyps.

Other problems in the pelvic area that can cause chronic pain

Scar tissue (
adhesions) inside the pelvis and belly. This is usually caused by pelvic inflammatory disease, radiation treatment, or surgery.

What Increases Your Risk

History of physical or sexual abuse. About half of women with chronic female pelvic pain
report abuse in their past.footnote 1

History of
radiation treatment or surgery of the abdomen or pelvis.
This includes some surgeries for urinary incontinence.

History of
depression. Pain and depression seem to be
related.

Alcohol or drug abuse.

Something
abnormal in the structure of the female organs.

Pregnancy and childbirth that put stress on the back and pelvis, such as delivery of a large baby, a difficult delivery,
or a forceps or vacuum delivery.

When To Call a Doctor

Call a doctor for immediate care if
you have sudden,
severe pelvic pain, with or without vaginal bleeding.

Call a
doctor if:

Your periods have changed from relatively
pain-free to painful.

Pain interferes with your daily
activities.

You start to have pain during
intercourse.

You have painful urination, blood in your urine, or an
inability to control the flow of urine.

You have blood in your stool
or a significant, unexplained change in your bowel movements.

You notice any new pelvic symptoms.

You haven't yet seen a doctor about your chronic pelvic pain.

Watchful waiting

Watchful waiting is a period of time during
which you and your doctor watch your pelvic pain symptoms
without using medical treatment.

During this period, you can keep a
daily record of your symptoms and menstrual cycle and any other life events that
you consider important. A watchful waiting period may last from a few days to
weeks or possibly months.

Who to see

The following primary health professionals can
generally evaluate and help you manage the symptoms of female pelvic
pain:

For advanced treatment methods,
see a
gynecologist or a urologist who specializes in female
pelvic disorders.

If you have ever been physically
or sexually abused, that trauma may
be playing a part in your pain. So you'll need to let your doctor know about the abuse. This may be hard for you, but it may be easier if you find a doctor you feel comfortable talking to.

Exams and Tests

Although your condition may be diagnosed during your first exam, don't be surprised if you need to have a series of
medical appointments and tests. For many women who have pelvic pain, diagnosing the
cause is a process of elimination that takes a while.

Even if tests don't find any problems, it doesn't mean that there's no physical cause for your chronic pain. Tests aren't yet able to detect all causes.

Initial tests

It's a good idea to make a calendar or
diary of your symptoms(What is a
PDF document?), menstrual cycle,
sexual activity, and physical exertion. And keep track of any other things that you think are
important, such as stressful events or illnesses. Bring it with you when you see your doctor.

To begin narrowing down the
list of possible causes of your pain, your doctor will review your
symptom diary and:

Ask about
your health history. This includes the history of your menstrual cycle and any pelvic surgery, radiation treatment, sexually transmitted infection,
pregnancy, or childbirth.

Do a
pelvic exam to look for signs of abnormalities. You may also have a
digital rectal exam . Your doctor may
conduct these exams in a slower, more thorough manner than a routine pelvic exam,
carefully checking for tender areas.

For abdominal wall "trigger points." These are specific places on your abdomen that cause pain when pressed.

Your mental health

Chronic pain can have a
wearing effect on the mind and emotions, which can in turn make harder to manage pain.

Your doctor may recommend a
mental health assessment . You'll be asked questions
to find out whether such conditions as
depression,
insomnia, or stress are adding to or being
caused by your chronic pain.

For the best chance of recovering from pain, you will need treatment for emotional problems like these, plus treatment for any known physical causes of pain.

Treatment Overview

Treatment for
chronic female pelvic pain can be approached in two
ways: treating a known, specific cause of the pain or treating the pain itself
as a medical condition. When it's possible, your doctor will do both.

Treating a known or suspected cause

Depending on the cause,
treatment may include:

Medicine to control or stop the
ovulation cycle. This is done if cyclic hormonal changes seem to
make your symptoms worse.

Healthy lifestyle choices, such as regular
exercise to manage stress and improve strength, mood, and general health, along
with dietary changes, such as those recommended to manage irritable bowel
syndrome.

Treating the pain itself

Finding a treatment that works may take a while. It's common for women to try many treatments before finding one or more that help.

Medicines that may help manage your pain include:

Nonsteroidal anti-inflammatory drugs
(NSAIDs) . These medicines are the first-choice treatment for relieving pain and inflammation. They work well for menstrual pain. Be safe with medicines. Read and follow all instructions on the label.

Medicines that control hormone levels, such as birth control pills. They sometimes work well for pain that seems to be caused or made worse by menstruation.

Certain antidepressant medicines. These are
used to treat chronic pain in other areas of the body also.

If your chronic pain hasn't responded to treatment or seems
to have no physical cause, you may have neuropathic pain. This means
that your nerves still create pain signals long after an original injury or
disease has healed. If your doctor suspects that you have
neuropathic pain, he or she may refer you to a
pain management clinic for evaluation and treatment.

What to think about

Decisions are complicated when you are considering treatment for chronic pelvic
pain. Think about these questions, and talk to your doctor about them:

Are the symptoms bothersome enough to require
treatment?

Do you want to have a child or more
children?

Has a specific cause of the pain been discovered? Or is
the cause unclear?

Is menopause, which may stop symptoms, going to
occur soon?

Would an opinion from another doctor be
helpful?

Would an opinion from a doctor who specializes in
chronic pain be helpful?

If you are close to menopause (usually around age 50) and your symptoms are likely related to hormones, your best option may be home treatment and medicine while you wait for menopause.

The hormone changes of menopause may get rid of your chronic pain, but the pain may come back if you use
hormone therapy. If you are nearing menopause, talk with your doctor about your options.

Prevention

Early diagnosis and treatment of pelvic pain
may help keep the pain from becoming chronic.

Medications

Medicine won't cure
female pelvic pain. But it can help control the pain and keep it from getting worse or becoming chronic. There is no one medicine that works for all women.

Medicines to control hormones

Birth control pills are commonly used for menstrual pain. They are also often prescribed for
endometriosis-related pain.

High-dose progestin
is sometimes prescribed for pain related to endometriosis.

Gonadotropin-releasing hormone agonists can relieve pain from endometriosis by stopping production
of the hormones that make endometriosis worse. This treatment may also
relieve pelvic pain that comes in cycles but isn't related to endometriosis and pelvic pain
related to
irritable bowel syndrome. But this short-term treatment brings on
symptoms of menopause, with side effects such as
hot flashes and loss of bone density, for as long as
you take it.

Surgery to remove reproductive organs may also help when
the cause of pain can't be found.footnote 1 When surgery, such as
hysterectomy or cutting of specific pelvic-area
nerves, is done for pain with no known cause, there is a risk of persistent
pain or pain that is worse after surgery. And it can have serious side effects.

Laparoscopy to diagnose chronic pelvic pain may be done before other treatment. Areas of endometriosis
or scar tissue may be removed or destroyed during the
laparoscopy.

Other Treatment

Chronic pelvic pain takes time to
develop and can take a long time to treat. Take charge of how you cope with
pain by using one or more of the treatment choices below. Combining your
medical treatment with these practices can help you keep a positive state of mind.

Counseling and stress management

Counseling and mental skills training help you learn the mental and emotional tools for managing
chronic pain and the stress that makes it worse. Combining
medical and psychological treatment increases your chances of treatment
success.

Commonly used treatments include:

Cognitive-behavioral therapy focused on changing the
way you think about and mentally manage pain. See a psychologist, licensed
counselor, or clinical social worker who specializes in pain management
skills.

Biofeedback . This is the conscious control of body
function that is normally unconsciously controlled.

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the
Terms of Use .
How this information was developed to help you make better health decisions.

Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC). In Arizona, individual HMO plans are insured by Cigna HealthCare of Arizona, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see a listing of the legal entities that insure or administer group HMO, dental HMO, and other products or services in your state). Group Universal Life (GUL) insurance plans are insured by CGLIC. Life (other than GUL), accident, critical illness, and disability plans are insured or administered by Life Insurance Company of North America, except in NY, where insured plans are offered by Cigna Life Insurance Company of New York. All insurance policies and group benefit plans contain exclusions and limitations. For availability, costs and complete details of coverage, contact a licensed agent or Cigna sales representative. This website is not intended for residents of New Mexico.

Selecting these links will take you away from Cigna.com. Cigna does not control the linked sites' content or links. Details